Local Effects of the Affordable Care Act

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Affordable Care Act

Jill Murphy, DPT, LAT, CSCS

Although the Affordable Care Act is really in its infancy of being the law of the healthcare land, there already have been some changes that the everyday person may be seeing in the local healthcare landscape, in covered medical charges, and in their pocketbook. Have you seen any of these changes yet (or others)?

One of the major goals of the Affordable Care Act (ACA) was to expand healthcare coverage to all. A secondary goal was to cut costs in the system, while expanding healthcare to all. You may not be a math genius, but when you consider both of these goals, you may realize what a tall task accomplishing both of those will actually be (without raising taxes). To solve this tricky problem, the financial impact of the ACA is being spread around not directly to consumers on your tax bill, but instead is spread by several changes: decreased reimbursement to all providers for services rendered to Medicare enrollees, changes to the financial gains that insurance companies can see, and taking money out of other programs such as Medicare to help fund ACA-dictated program expansions.

From afar, these seem like good changes - Americans get more healthcare access without paying for it directly. However, if you analyze the effects we are already seeing from these changes, each and every American will be directly and both positively and negatively affected by the ACA. This April, due to both the sequester and changes dictated in the ACA, all Medicare providers will take a ~5-6% decrease in reimbursement from Medicare for providing the same treatments to Medicare beneficiaries. These same providers already saw a 6% decrease in Medicare reimbursement in 2011. The impact is already being felt in the Fox Valley area, as several providers no longer take Medicare and Medicaid beneficiaries as patients, reducing the pool of potential providers and limiting healthcare access for these patients.

ObamacareAlso in the Green Bay and Fox Valley area, Bellin and Thedacare have developed one of the pioneering ACO (accountable care organizations) in the country. The idea in the ACA was to cut costs and improve quality, but at the same time, this now gives those organizations even more financial incentive (and more protection from any legal action) to keep all patients (especially Medicare patients) in-house, even if those patients could receive better quality care outside of those organizations. At MotionWorks we have noticed the difference in many local organizations’ outright refusal to refer a patient to MotionWorks for physical therapy, even though the patient has specifically requested it. This is still illegal behavior even under the ACA, as you as the patient are still allowed to go anywhere for your care, but organizations are getting more brazen in telling patients “no” to outside referrals. So the question remains, will the ACA improve quality of care, and by whose standards is quality of care measured? Hint: it’s not the patient who gets to decide what quality is. ACO’s are financially rewarded by the government for keeping more patients from being re-admitted to the ER or hospital within 30 days of a hospital discharge. ACO’s can be financially punished if they do not meet a minimum standard goal for these re-admissions. This is the government definition of quality of care.

There are some benefits to the changes in the ACA to be sure. If you are in your lower 20’s, you can stay on your parent’s health insurance until you are 26. All prenatal visits are now covered (although “all” does not include every charge for tests and ultrasounds), and insurance companies will be required to cover pre-existing conditions. The tough reality is however, that insurance companies are a business, and businesses have an expectation for making a profit. What are the chances that other small benefits already in insurance plans will not be diminished to make up for any loss of profit from ACA changes? For your healthcare providers - primary doctors, specialists, physical therapists, and so many others, because nearly all healthcare is reimbursed by insurance or Medicare, there is no opportunity to make up the losses from the reduced reimbursements contained in the ACA. This will mean fewer consumer choices for providers, and fewer providers overall; after all, would you stay in a job where you have been paid less and less every year for the past ten years? Would a student think this is a great career choice, where your pay actually gets reduced every year, even as tuition costs skyrocket and the bureaucratic burden of paperwork increases exponentially?

Something has to give, and as the full effects of the ACA are realized in the next two years, we all will observe what that will be. No one really knows the true, full effect of the ACA on our healthcare system, and time will only tell. Do you have thoughts about these changes in healthcare? Weigh in on our Facebook page and continue the conversation.